| NPI | 1619575875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 202100765NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200941772) |
| 163WG0000X Registered Nurse, General Practice (Licence: OR 200941772RN) | |
| 163W00000X Registered Nurse (Licence: OR 200941772RN) | |
| Enumeration Date | 2020-10-11 |
| Last Update Date | 2021-08-17 |